Effectiveness and Safety of Ketamine-Propofol Versus Ketamine-Midazolam Combinations in Endoscopic Cholangiopancreatography: A Prospective Observational Study

Abstract

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) requires effective sedation and analgesia. Ketamine–propofol and ketamine–midazolam is commonly used, but comparative data in ERCP are limited.

Objective: To compare the effectiveness and safety of ketamine–propofol (KP) versus ketamine–midazolam (KM) for procedural sedation during ERCP.

Methods: This prospective observational study included 50 ASA I–II patients aged 18–70 years undergoing ERCP, equally allocated to two groups. The KP group received ketamine–propofol 1:1 (0.5 mg/kg loading dose, 2–3 mg/kg/h infusion). The KM group received ketamine 0.5 mg/kg plus midazolam 0.02 mg/kg, with supplemental doses as required. Sedation was targeted to a Ramsay score of 5. Time to achieve targeted Ramsey Sedation Score after induction, patient needing rescue sedation, hemodynamic variables, recovery time, and adverse events were recorded. Data were analyzed using t-tests and chi-square tests, with P < 0.05 considered significant.

Results: Group KP achieved faster sedation than Group KM (184.80 ± 48.74 vs. 314.40 ± 92.11 seconds; P value < 0.001) and shorter recovery time (7.92 ± 1.89 vs. 9.48 ± 2.25 min; P value < 0.05). Discharge time was similar between groups. Hemodynamic parameters were lower in the KP group after induction. Desaturation and airway maneuvers were more frequent with KP while post procedure nausea and vomiting and recovery agitation were more common with KM group, though not statistically significant.

Conclusion: Both regimens were effective for ERCP sedation. Ketamine–propofol provided faster onset, quicker recovery and better hemodynamic control, but with more respiratory adverse events.